ArticleJournal of the National Cancer Institute2024
Health insurance among survivors of childhood cancer following Affordable Care Act implementation.
Article in Journal of the National Cancer Institute, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Insurance, legal, and financial hardships of childhood and adolescent cancer survivors-a systematic review.Journal of cancer survivorship : research and practice · 2026Pooled it
- Changes in Medicaid Enrollment Among Adult Survivors of Childhood Cancer After Medicaid Expansion: A Report From the Childhood Cancer Survivor Study.JCO oncology practice · 2026Article
- [Current status and prospects of family financial toxicity in childhood malignancies].Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics · 2026Review
- Predictors of long-term follow-up clinic attendance and continued engagement among survivors of cancer in childhood and adolescence.Journal of cancer survivorship : research and practice · 2025Article
- Assessing the effect of virtual navigation interventions to improve health insurance literacy and decrease financial burden in cancer survivors: The HINT II study protocol.Contemporary clinical trials · 2025Article
- Development of a Health Insurance Navigation Program for Long-Term Childhood Cancer Survivors.Health education & behavior : the official publication of the Society for Public Health Education · 2025Article
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Authors and funding
13 authors.
Funding
Abstract
backgroundThe Affordable Care Act (ACA) increased private nonemployer health insurance options, expanded Medicaid eligibility, and provided preexisting health condition protections. We evaluated insurance coverage among long-term adult survivors of childhood cancer pre- and post-ACA implementation.
methodsUsing the multicenter Childhood Cancer Survivor Study, we included participants from 2 cross-sectional surveys: pre-ACA (2007-2009; survivors: n = 7505; siblings: n = 2175) and post-ACA (2017-2019; survivors: n = 4030; siblings: n = 987). A subset completed both surveys (1840 survivors; 646 siblings). Multivariable regression models compared post-ACA insurance coverage and type (private, public, uninsured) between survivors and siblings and identified associated demographic and clinical factors. Multinomial models compared gaining and losing insurance vs staying the same among survivors and siblings who participated in both surveys.
resultsThe proportion with insurance was higher post-ACA (survivors pre-ACA 89.1% to post-ACA 92.0% [+2.9%]; siblings pre-ACA 90.9% to post-ACA 95.3% [+4.4%]). Post-ACA insurance increase in coverage was higher among those aged 18-25 years (survivors: +15.8% vs +2.3% or less ages 26 years and older; siblings +17.8% vs +4.2% or less ages 26 years and older). Survivors were more likely to have public insurance than siblings post-ACA (18.4% vs 6.9%; odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.1 to 2.6). Survivors with severe chronic conditions (OR = 4.7, 95% CI = 3.0 to 7.3) and those living in Medicaid expansion states (OR = 2.4, 95% CI = 1.7 to 3.4) had increased odds of public insurance coverage post-ACA. Among the subset completing both surveys, low- and mid-income survivors (<$40 000 and <$60 000, respectively) experienced insurance losses and gains in reference to highest household income survivors (≥$100 000), relative to odds of keeping the same insurance status.
conclusionsPost-ACA, more childhood cancer survivors and siblings had health insurance, although disparities remain in coverage.
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